Personalized prevention approach with use of a web-based cardiovascular risk assessment with tailored lifestyle follow-up in primary care practice--a pilot study.

Abstract

The aim of this prospective implementation study is to evaluate feasibility of a personalized prevention approach with use of a web-based health risk assessment for cardiovascular diseases combined with tailored lifestyle feedback and interventions in the community setting. A random sample of 800 inhabitants of Leidsche Rijn (a newly built residential area in the city of Utrecht) between 45 and 70 years old was invited by their general practitioner to participate in this study and sent a web-based health risk assessment containing a questionnaire, covering socio-demographic variables, family and personal medical history, lifestyle behaviour and psychological variables. The system generates an individual cardiovascular risk based on prognostic modelling. In the case of increased risk further biometric and laboratory evaluation is advised. All participants received tailored web-based feedback with an electronic referral to available medical, psychological and lifestyle interventions in the neighbourhood, or online interventions, and a follow-up questionnaire after six months. The participation rate was 29% (230/800) of which 39% (89/230) were at increased risk for cardiovascular disease and were advised to perform biometric measures, of which 36% (32/89) actually did. Of these respondents 25% (8/32) had increased blood pressure (≥140/90), 56% (18/32) increased total cholesterol (>6.0 mmol/l).One-third of the participants started changing their lifestyle, 20% indicated planning to do this later; 32% (41/129) increased their physical activity and 28% (36/129) were eating healthier. Seventy-nine per cent of the responders stated their participation was 'meaningful'. The personalized prevention approach offers a system for integrated risk profiling and individualized health management that was well received in general practice. The client-centred approach, which was embedded in a local community setting, using a web-based health risk assessment with tailored feedback and linkage to regional health management and lifestyle providers proved feasible, and successful. Participating in the health risk assessment elicited actual behaviour change among follow-up survey respondents.